Provider Demographics
NPI:1770627911
Name:EGGER, WILLIS DAVID (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIS
Middle Name:DAVID
Last Name:EGGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 N CONWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-4008
Mailing Address - Country:US
Mailing Address - Phone:956-519-9398
Mailing Address - Fax:956-519-7166
Practice Address - Street 1:1609 N CONWAY AVE.
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572
Practice Address - Country:US
Practice Address - Phone:956-519-9398
Practice Address - Fax:956-519-7166
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182396501Medicaid